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Regulatory Nurse Case Manager

ADP
  • Remote
    30+ days ago

    Job Description

    Benefits:
    • 401(k)
    • 401(k) matching
    • Bonus based on performance
    • Company parties
    • Dental insurance
    • Employee discounts
    • Free food & snacks
    • Health insurance
    • Opportunity for advancement
    • Paid time off
    • Parental leave
    • Savings bank
    • Training & development
    • Vision insurance
    • Wellness resources
    About the Role:
    MedPOINT Management in Sherman Oaks, CA is looking for a detail-oriented and driven Regulatory Case Manager to join our growing team. In this critical role, you'll help ensure compliance and streamline regulatory processes that directly impact patient care and organizational success. If you thrive in a fast-paced healthcare environment and have a passion for precision, this is the opportunity for you.


    Responsibilities:
    • Manage and oversee regulatory cases from initiation through resolution, ensuring timely and compliant outcomes
    • Review, analyze, and process regulatory submissions, appeals, and grievances in accordance with state and federal guidelines
    • Coordinate with internal departments, providers, and external agencies to gather documentation and facilitate case resolution
    • Monitor regulatory deadlines and maintain accurate case tracking logs and reporting systems
    • Prepare written correspondence, case summaries, and regulatory reports for internal and external stakeholders
    • Ensure adherence to DMHC, CMS, and other applicable healthcare regulatory requirements
    • Identify trends in regulatory cases and recommend process improvements to enhance compliance operations
    Requirements:
    • 2+ years of experience in regulatory affairs, healthcare compliance, or case management
    • Strong knowledge of healthcare regulations, including DMHC, CMS, or managed care guidelines
    • Excellent written and verbal communication skills with the ability to draft clear, professional correspondence
    • Proficiency in case management systems and Microsoft Office Suite
    • Strong organizational skills with the ability to manage multiple deadlines simultaneously
    • Bachelor's degree in Healthcare Administration, Business, or a related field preferred
    • Detail-oriented, analytical mindset with a commitment to accuracy and compliance
    About Us:
    MedPOINT Management is a leading Independent Physician Association (IPA) management company based in Sherman Oaks, CA, dedicated to supporting healthcare providers and delivering high-quality managed care services. Our clients trust us for our deep expertise, responsive service, and commitment to operational excellence. Our team members enjoy a collaborative work culture, opportunities for professional growth, and the satisfaction of making a meaningful impact in the healthcare industry.

    This is a remote position.

    Compensation: $35.00 - $40.00 per hour




    Numbers & Facts

    Location (
    Remote
    )
    IndustryManagement Consulting Services
    Company Size10,000 employees or more
    Websitehttps://jobs.adp.com/life-at-adp/

    About Company

    ADP powers the working world with comprehensive solutions that drive business success. Consistently named one of the "Most Admired Companies" by FORTUNE® Magazine, and recognized by Forbes® as one of "The World's Most Innovative Companies," ADP has over a half-million clients around the globe and 65 years of experience as one of the largest providers of human capital management solutions world-wide. At ADP, we believe that diversity fuels innovation. ADP is committed to equal employment opportunities regardless of race, color, genetic information, creed, religion, sex, sexual orientation, gender identity, lawful alien status, national origin, age, marital status, non-job related physical or mental disability, or protected veteran status. We support an inclusive workplace where associates excel based on personal merit, qualifications, experience, ability, and job performance.

    Skills

    • Analysis Skillsunmatched
    • Case Managementunmatched
    • Certified Case Manager (CCM)unmatched
    • Communication Skillsunmatched
    • Content Management Systems (CMS)unmatched
    • Dental Insuranceunmatched
    • Detail Orientedunmatched
    • Documentationunmatched
    • Health Insuranceunmatched
    • Healthcareunmatched
    • Healthcare Administrationunmatched
    • Healthcare Providersunmatched
    • Maintain Complianceunmatched
    • Managed Careunmatched
    • Microsoft Officeunmatched
    • Monitor Regulationsunmatched
    • Organizational Skillsunmatched
    • Patient Careunmatched
    • Prepare Correspondenceunmatched
    • Presentation/Verbal Skillsunmatched
    • Process Analysisunmatched
    • Process Developmentunmatched
    • Process Improvementunmatched
    • Regulationsunmatched
    • Regulatory Reportsunmatched
    • Regulatory Requirementsunmatched
    • Regulatory Submissionsunmatched
    • Savings Bankunmatched
    • Team Playerunmatched
    • Time Managementunmatched
    • Training/Teachingunmatched
    • Trend Analysisunmatched
    • Vision Planunmatched
    • Writing Skillsunmatched

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